| Regimental number | 19622 |
| Place of birth | Creswick Vic |
| Religion | Church of England |
| Occupation | Clerk |
| Address | Maylands, Western Australia |
| Marital status | Single |
| Age at embarkation | 18 |
| Next of kin | Father, A C Haselhurst, Railway Terrace, Maylands, Western Australia |
| Enlistment date | 25 June 1917 |
| Date of enlistment from Nominal Roll | 28 May 1917 |
| Rank on enlistment | Private |
| Unit name | Army Medical Corps, October 1917 Reinforcements |
| AWM Embarkation Roll number | 26/99/2 |
| Embarkation details | Unit embarked from Fremantle, Western Australia, on board HMAT Canberra on 23 November 1917 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 3rd Field Ambulance |
| Fate | Returned to Australia 23 July 1919 |
